The Imaginal Institute

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"We are so far off track, that if we were to get on track, we would think that we were off track."
Anonymous

“ Dr. Guarnieri isn’t there something really wrong going on,
given that 12 of the 13 boys on my son’s baseball team are on Ritalin ? “
A Parent in Consultation

 

Beginning my 30th year as a child and adolescent psychotherapist, I have  witnessed thousands of sand pictures and sculptures, played thousands of games of checkers, shoots and ladders, studied hundreds of theories,  experienced innumerable somatic reactions, and awakened at night countless times, worrying about children.

For a long time, I have been disturbed by the practices of child psychotherapy, and I am hereby giving a shout to my community of psychotherapists.

I bring an approach and a way of being that are crucial for engaging with young people and families seeking guidance – a practice that includes as many perceptions and bodies of knowledge as possible. This contradicts what I see as the current trend of practice based on a predominantly medical/pharmacological and neurobiological model.

I am a proponent of child psychotherapy that is deeply attuned to powerful archetypal and cultural forces. It is based on sociopolitical concerns, and it advocates for children and families who have been under psychological, cultural and economic siege for decades.

This approach evolves from no predominant school of thought, is non-reductionist, non-pathologizing, and non-pharmacological.  It reclaims and revisions the experiences and lives of children who have been marginalized and subjugated by mainstream perceptions and the predatory influence of adults in positions of power. It also looks deeply at the narrowness and tyranny of mainstream psychotherapeutic practice.  It rails against pop psychology, the computer takeover of children’s imaginations, uninteresting schools, unhealthy  food, and the loss of nature in the experience of children.

This way of working focuses on the complexities underlying a child's life; it works to understand their symptoms and presenting behaviors, and to envision these phenomena as strengths in disguise. It requires an indwelling and communing with the child’s prima materia., including everything that emerges within the psychotherapeutic space; at times, it is a journey to Hades. While it sometimes necessitates a long and grueling process, this work requires a paradigm shift: to relinquish the prevailing sickness metaphor that dominates our wonderful art of practice. Ironically, the current state of psychotherapy for children transmogrifies the very direction in which it purports to go.

This approach enables children to embrace life in a new way, understand the internal and external forces that impede them, access their inner resources and stories, and learn to experience life’s mystery and beauty.

The industry of psychotherapy and psychiatry is providing children with the psychological equivalent of fast food. Deadened practice, with its dead language and diagnoses, fails before it ever begins.  Many practitioners prescribe medication over the phone; others think they know the child before they   ever see them; psychological assessments are reduced to checklists; testing omits entire bodies of knowledge. What happened to our beautiful work?

Psychotherapy has eliminated vast understandings and experiences that consider the child’s ethnicity, somatic experiences, archetypal forces, mythology, race, spirituality, and more.  In addition, our practices are often based on a relentlessly Eurocentric point of view originating 100 years ago in Vienna, eliminating much of the world’s culture and mythology.  How would psychotherapy evolve if it emerged from Firenze, Chiapas, Tel Aviv, Kyoto or Nairobi?  Don’t other cultures have their own glorious healing practices?  Where do other cultural healing practices show up in our theories? How did pathos (suffering) turn into pathology?  How did therapeia (care of the soul) turn into pop psychology?

I recently worked with a teen who had serious brain damage from birth, was burdened with a 65 IQ, and had a history of failure in schools that could not help him.  While he had serious realities to negotiate, he also had many qualities that were marginalized or missed; everyone assumed he couldn’t achieve much because of his low IQ. For years, I worked to help him find his place in the world, and he eventually matured into a wonderful young man with expertise in working with cars and trucks. His “diagnosis” of brain damage, and the “help” he received did not help him develop a full life.

I believe that if we fail to find a viable place for someone in society, it is a cultural and sociological failing rather than a psychological failing, and it needs to be named as such, rather than blamed on the child or family.  This is extremely evident in the racist, classist culture in which we live.

In the past 30 years, the field of child psychotherapy has lost its direction and  generated little creativity.  The profession is caught in the stranglehold of pharmacology, the corporate medical elite, and a powerful litigious environment.   Many therapists practice within a narrow state of fear, eliminating great possibilities for their clients. Just when children enter the dark night of the soul – precisely what depth psychotherapy asks them to do - we medicate or hospitalize them. We prescribe anti-psychotic drugs to squelch an angry child without exploring, broadly and deeply, WHY they are angry. Primordial material often scares practitioners who want to control their clients in order to avoid judgments, the emotional burden of difficult work, and potential legal repercussions.

I believe that a therapist’s most vital  "technique" is their attitude of mind, practicing outside the dictates of traditional forces. We must listen with an aesthetic ear, and pay attention not only to what we see, but how we see, and how we see through the inflexible indoctrinations of practice.

Where is the imaginative nature of our practice?  When we are faced with  “intractable” situations, doesn’t the problem lie in the therapist’s and the culture’s failure of imagination?  And if we don’t have the time or desire to figure out the complications, what is fueling this dynamic?

My primary guideline in child psychotherapy is the activation of imagination  situated within a meaningful relationship – a relationship  committed to working with all of the psyche’s powerful  forces. This means having a deep conviction to believe in the child and what they are saying, no matter what…even if you don’t believe it!  It means believing in the images they make, and immersing oneself in an alchemical process, while letting go of what we think we know. This includes contending with the vagaries of mainstream perceptions and the call for a quick fix.  Depth psychotherapy does not move fast and the psyche has a mind of it’s own.

Using an aesthetic perception allows us to see through to the deepest realms within the child in order  to detect their spiritual, numinous qualities and possibilities.  It also calls for a poetic imagination.  

I worked for many years with a challenging child who had been abused, was very aggressive, and failing in school. One day in our session, he decided to shape walls along the sand tray, and mix hot salt water in the middle of the space he created. He closed his eyes, and without saying a word, let his hands rest in the water for a long time. Then he invited me to put my hands in with him, and together we quietly rested our hands in the water. He said “Oh it feels so good,” and I told him, “You have finally found a warm, safe place for yourself.” Nothing else had to be said. For a moment, he had created an experience that put his demons to rest. He was much calmer for months following this session, which could only have occurred in the context of creating a rapport with me over a long period of time, and allowing the space for him to be creative, to honor the generative power of his imagination.

We must not be seduced by our clients’ initial “symptoms” and problematic behaviors. Our initial perceptions are part of the profound indoctrination that has seized us; this is why I introduce the concept of undiagnosing the client. I am calling for the removal of most medical terminology and orientation in the practice of depth- oriented child psychology. Where is the mythic, the spiritual, the common sense in our practice?

I remember observing a boy whose class had a substitute teacher for the day.  I went to his school at the beginning of the day, and when I spoke with the teacher, she told me she believed he was ADHD. This was her diagnosis after spending 20 minutes with him! 

Consider this: I hear children on a playground talking about taking different colored pills that make them behave properly, each “diagnosing” themselves, mentioning three medications by name. For the first time in history, children know the names of psychiatric drugs and DSM diagnoses! 

Why are we beholden to the patriarch of medicine? Have we forgotten the power of connection, that the therapeutic relationship allows the soul to emerge in the most meaningful ways?  If a child can embrace the therapist as a benevolent adult guide, it creates a psychological climate allowing the imaginal to emerge.  Isn’t it our job to facilitate our clients’ innate impulse toward psycho-spiritual well- being, and to get out of the way of its vital flow?  Where is our depth of understanding, and who are the wise elders who can lead and mentor us?

Each child can learn to embrace life, see beyond the forces that hold them back, access their inner resources, tap into the infinite stories inside them, experience mystery and beauty, and believe in themselves. What does this require of the therapist and the culture?  It requires time, commitment, devotion and a willingness to throw oneself unreservedly into the process, heart and soul.

The pervasive pathologizing, projecting, over diagnosing, mal-diagnosing, and  medicating of children has created a harsh climate of psychological anxiety that  must  be addressed aggressively.  For a child, diagnosis is a psychological assault that becomes a scarlet letter haunting them for years. Re-imagining psychopathology means coming to terms with who gets to call something psychopathological.

Psychopathology is a lucrative market-driven business with the goal of generating prodigious wealth.  I seriously doubt that pharmaceutical companies know or care about the hearts and souls of children.  While children may sometimes – if rarely – require medication, medicating away their experiences as a common practice is an insidious process that gives parents and children false hope about improvements, and blocks or numbs crucial experiences children need.  Children feel awful about taking the little white pill, the family might stop looking at itself, teachers are pleased because the child is well behaved, deep psychological work cannot ensue, and a long-lasting stigma is marked upon the child’s psyche and the collective culture. 

The shadow created by these narrow perceptions and approaches has caused much harm to our children, families and the culture, and will create even bigger problems in the years to come. I deeply believe that the art of child psychotherapy has yet to be discovered, and in 100 years our society will look back in shock over the “treatments” and practices we have unleashed upon our children.

I leave you with the words of Rumi:

The breeze at dawn has secrets to tell you.
Don't go back to sleep.
You must ask for what you really want.
Don't go back to sleep.
People are going back and forth across the door sill,
Where the two worlds touch.
The door is round and open.
Don't go back to sleep.

 

© Anthony Guarnieri, Ph.D. All Rights Reserved.
Published with permission from the author.
Originally published in Viewpoint, a periodical from the Psychotherapy Institute in Berkeley, California.
May/June 2007

To contact Dr. Guarnieri, email him at AGuarnieri(at)ciis.edu. (Replace the (at) with an @.)

Click here to visit Anthony Guarnieri's Imaginal Institute Fellow's Page.